Nearly 95 Percent of Low-Income Uninsured Children Now Are Eligible for Medicaid or SCHIP
Measures Need to Increase EnrollmentAmong Eligible But Uninsured Children
by Matthew Broaddus and Leighton Ku
Due to recent expansions in Medicaid coverage for children and state health insurance programs for children, the overwhelming majority of low-income children in the United States now are eligible for health insurance. A new analysis of Census data, presented here, finds that 94 percent of all uninsured children with family incomes below twice the poverty line - currently $28,300 for a family of three - qualify for Medicaid or a separate state child health insurance program supported by SCHIP funds. (SCHIP stands for the State Children's Health Insurance Program, established under legislation enacted in 1997.)
* In 1999, there were 7.1 million low-income uninsured children in the country. ("Low-income" is defined here as having family income below twice the poverty line.)
* Some 6.7 million of these children were eligible for child health insurance using the state eligibility standards now in place....
... Simplifying application and redetermination procedures. States can redesign application and redetermination forms so they are more user-friendly. States can make sure the questions on the forms are clear, can pare unnecessary questions, and can reduce verification burdens on families seeking to apply for or maintain their children's coverage. Examples of ways to simplify the application and redetermination processes that are permissible under current federal rules include dropping face-to-face interview requirements, allowing applications and redetermination forms to be mailed in, dispensing with or greatly simplifying asset tests, and instituting presumptive eligibility and 12-month continuous eligibility for children, both of which are state options. (Under 12-month continuous eligibility, states may certify a child for Medicaid or SCHIP for a 12-month period, eliminating the need for an application for the second six month period and other cumbersome reporting requirements.)
* Making Medicaid and state SCHIP eligibility policies and procedures more similar. As part of their separate SCHIP programs, many states have developed innovative methods to simplify eligibility criteria, reduce stigma, and make it easier for working families to apply for their children, but some states have not made corresponding changes in their Medicaid programs for children. Doing so should increase enrollment in Medicaid among children from working poor families. For example, if a state uses mail-in applications or has eliminated its asset test for SCHIP, it could make corresponding changes in its Medicaid program.
* Expanding application sites. States can outstation eligibility workers in settings such as clinics and hospitals to help sign up eligible children. They also can provide grants to community-based organizations to help complete applications; this may be particularly useful in minority, ethnic or rural communities that may have less-than-adequate access to eligibility offices.
* Using school lunch information to identify eligible children in need of coverage. As noted earlier, large numbers of uninsured low-income children might gain coverage if Medicaid and SCHIP agencies coordinated efforts with school lunch programs. This approach has the potential to reach millions of uninsured low-income children who already have been determined to have low incomes. Even without the enactment of federal legislation allowing states to let schools make "presumptive eligibility" determinations for Medicaid, there is much that schools and Medicaid and SCHIP agencies can do to use data on children who qualify for free or reduced-price school lunches to identify and reach low-income children eligible for Medicaid and separate SCHIP-funded programs.
* Expanding eligibility for low-income parents. Recent research indicates that state expansions of Medicaid eligibility for parents lead to increased Medicaid participation rates among eligible children.(14) In addition to offering coverage to uninsured low-income parents, state efforts to expand eligibility to these parents thus may reduce the number of uninsured children. Current federal rules for Medicaid and SCHIP offer a variety of options to states to expand eligibility for low-income parents and families, using federal waivers or rules for using "less restrictive" methods of counting income. In recent years, about one-third of the states have adopted eligibility expansions of this nature for parents. In addition, the Health Care Financing Administration recently released guidance enabling states, under certain circumstances, to secure federal waivers that allow them to use a portion of their unspent SCHIP funds to expand coverage for parents.(15)
By expanding eligibility standards for Medicaid and SCHIP-funded programs, states have made most uninsured low-income children eligible for health insurance. Millions of eligible children remain uninsured, however, largely because of administrative barriers to Medicaid and SCHIP enrollment. Congress and the states need to do more to facilitate enrollment in child health insurance programs by streamlining and simplifying the process of enrolling children and families, as well as by closing the eligibility gap for low-income legal immigrant children who have recently entered the United States.
[The full article is available at <http://www.cbpp.org/12-6-00schip.htm>.]